VR-FuseNet: A Fusion of Heterogeneous Fundus Data and Explainable Deep Network for Diabetic Retinopathy Classification

Diabetic retinopathy is a severe eye condition caused by diabetes where the retinal blood vessels get damaged and can lead to vision loss and blindness if not treated. Early and accurate detection is key to intervention and stopping the disease progressing. For addressing this disease properly, this paper presents a comprehensive approach for automated diabetic retinopathy detection by proposing a new hybrid deep learning model called VR-FuseNet. Diabetic retinopathy is a major eye disease and leading cause of blindness especially among diabetic patients so accurate and efficient automated detection methods are required. To address the limitations of existing methods including dataset imbalance, diversity and generalization issues this paper presents a hybrid dataset created from five publicly available diabetic retinopathy datasets. Essential preprocessing techniques such as SMOTE for class balancing and CLAHE for image enhancement are applied systematically to the dataset to improve the robustness and generalizability of the dataset. The proposed VR-FuseNet model combines the strengths of two state-of-the-art convolutional neural networks, VGG19 which captures fine-grained spatial features and ResNet50V2 which is known for its deep hierarchical feature extraction. This fusion improves the diagnostic performance and achieves an accuracy of 91.824%. The model outperforms individual architectures on all performance metrics demonstrating the effectiveness of hybrid feature extraction in Diabetic Retinopathy classification tasks. To make the proposed model more clinically useful and interpretable this paper incorporates multiple XAI techniques. These techniques generate visual explanations that clearly indicate the retinal features affecting the model's prediction such as microaneurysms, hemorrhages and exudates so that clinicians can interpret and validate.

Integrating Non-Linear Radon Transformation for Diabetic Retinopathy Grading

Diabetic retinopathy is a serious ocular complication that poses a significant threat to patients' vision and overall health. Early detection and accurate grading are essential to prevent vision loss. Current automatic grading methods rely heavily on deep learning applied to retinal fundus images, but the complex, irregular patterns of lesions in these images, which vary in shape and distribution, make it difficult to capture subtle changes. This study introduces RadFuse, a multi-representation deep learning framework that integrates non-linear RadEx-transformed sinogram images with traditional fundus images to enhance diabetic retinopathy detection and grading. Our RadEx transformation, an optimized non-linear extension of the Radon transform, generates sinogram representations to capture complex retinal lesion patterns. By leveraging both spatial and transformed domain information, RadFuse enriches the feature set available to deep learning models, improving the differentiation of severity levels. We conducted extensive experiments on two benchmark datasets, APTOS-2019 and DDR, using three convolutional neural networks (CNNs): ResNeXt-50, MobileNetV2, and VGG19. RadFuse showed significant improvements over fundus-image-only models across all three CNN architectures and outperformed state-of-the-art methods on both datasets. For severity grading across five stages, RadFuse achieved a quadratic weighted kappa of 93.24%, an accuracy of 87.07%, and an F1-score of 87.17%. In binary classification between healthy and diabetic retinopathy cases, the method reached an accuracy of 99.09%, precision of 98.58%, and recall of 99.6%, surpassing previously established models. These results demonstrate RadFuse's capacity to capture complex non-linear features, advancing diabetic retinopathy classification and promoting the integration of advanced mathematical transforms in medical image analysis.

Enhancing DR Classification with Swin Transformer and Shifted Window Attention

Diabetic retinopathy (DR) is a leading cause of blindness worldwide, underscoring the importance of early detection for effective treatment. However, automated DR classification remains challenging due to variations in image quality, class imbalance, and pixel-level similarities that hinder model training. To address these issues, we propose a robust preprocessing pipeline incorporating image cropping, Contrast-Limited Adaptive Histogram Equalization (CLAHE), and targeted data augmentation to improve model generalization and resilience. Our approach leverages the Swin Transformer, which utilizes hierarchical token processing and shifted window attention to efficiently capture fine-grained features while maintaining linear computational complexity. We validate our method on the Aptos and IDRiD datasets for multi-class DR classification, achieving accuracy rates of 89.65% and 97.40%, respectively. These results demonstrate the effectiveness of our model, particularly in detecting early-stage DR, highlighting its potential for improving automated retinal screening in clinical settings.

Progressive Transfer Learning for Multi-Pass Fundus Image Restoration

Diabetic retinopathy is a leading cause of vision impairment, making its early diagnosis through fundus imaging critical for effective treatment planning. However, the presence of poor quality fundus images caused by factors such as inadequate illumination, noise, blurring and other motion artifacts yields a significant challenge for accurate DR screening. In this study, we propose progressive transfer learning for multi pass restoration to iteratively enhance the quality of degraded fundus images, ensuring more reliable DR screening. Unlike previous methods that often focus on a single pass restoration, multi pass restoration via PTL can achieve a superior blind restoration performance that can even improve most of the good quality fundus images in the dataset. Initially, a Cycle GAN model is trained to restore low quality images, followed by PTL induced restoration passes over the latest restored outputs to improve overall quality in each pass. The proposed method can learn blind restoration without requiring any paired data while surpassing its limitations by leveraging progressive learning and fine tuning strategies to minimize distortions and preserve critical retinal features. To evaluate PTL's effectiveness on multi pass restoration, we conducted experiments on DeepDRiD, a large scale fundus imaging dataset specifically curated for diabetic retinopathy detection. Our result demonstrates state of the art performance, showcasing PTL's potential as a superior approach to iterative image quality restoration.

Diabetic Retinopathy Detection Based on Convolutional Neural Networks with SMOTE and CLAHE Techniques Applied to Fundus Images

Diabetic retinopathy (DR) is one of the major complications in diabetic patients' eyes, potentially leading to permanent blindness if not detected timely. This study aims to evaluate the accuracy of artificial intelligence (AI) in diagnosing DR. The method employed is the Synthetic Minority Over-sampling Technique (SMOTE) algorithm, applied to identify DR and its severity stages from fundus images using the public dataset "APTOS 2019 Blindness Detection." Literature was reviewed via ScienceDirect, ResearchGate, Google Scholar, and IEEE Xplore. Classification results using Convolutional Neural Network (CNN) showed the best performance for the binary classes normal (0) and DR (1) with an accuracy of 99.55%, precision of 99.54%, recall of 99.54%, and F1-score of 99.54%. For the multiclass classification No_DR (0), Mild (1), Moderate (2), Severe (3), Proliferate_DR (4), the accuracy was 95.26%, precision 95.26%, recall 95.17%, and F1-score 95.23%. Evaluation using the confusion matrix yielded results of 99.68% for binary classification and 96.65% for multiclass. This study highlights the significant potential in enhancing the accuracy of DR diagnosis compared to traditional human analysis

Early detection of diabetes through transfer learning-based eye (vision) screening and improvement of machine learning model performance and advanced parameter setting algorithms

Diabetic Retinopathy (DR) is a serious and common complication of diabetes, caused by prolonged high blood sugar levels that damage the small retinal blood vessels. If left untreated, DR can progress to retinal vein occlusion and stimulate abnormal blood vessel growth, significantly increasing the risk of blindness. Traditional diabetes diagnosis methods often utilize convolutional neural networks (CNNs) to extract visual features from retinal images, followed by classification algorithms such as decision trees and k-nearest neighbors (KNN) for disease detection. However, these approaches face several challenges, including low accuracy and sensitivity, lengthy machine learning (ML) model training due to high data complexity and volume, and the use of limited datasets for testing and evaluation. This study investigates the application of transfer learning (TL) to enhance ML model performance in DR detection. Key improvements include dimensionality reduction, optimized learning rate adjustments, and advanced parameter tuning algorithms, aimed at increasing efficiency and diagnostic accuracy. The proposed model achieved an overall accuracy of 84% on the testing dataset, outperforming prior studies. The highest class-specific accuracy reached 89%, with a maximum sensitivity of 97% and an F1-score of 92%, demonstrating strong performance in identifying DR cases. These findings suggest that TL-based DR screening is a promising approach for early diagnosis, enabling timely interventions to prevent vision loss and improve patient outcomes.

Wavelet-based Global-Local Interaction Network with Cross-Attention for Multi-View Diabetic Retinopathy Detection

Multi-view diabetic retinopathy (DR) detection has recently emerged as a promising method to address the issue of incomplete lesions faced by single-view DR. However, it is still challenging due to the variable sizes and scattered locations of lesions. Furthermore, existing multi-view DR methods typically merge multiple views without considering the correlations and redundancies of lesion information across them. Therefore, we propose a novel method to overcome the challenges of difficult lesion information learning and inadequate multi-view fusion. Specifically, we introduce a two-branch network to obtain both local lesion features and their global dependencies. The high-frequency component of the wavelet transform is used to exploit lesion edge information, which is then enhanced by global semantic to facilitate difficult lesion learning. Additionally, we present a cross-view fusion module to improve multi-view fusion and reduce redundancy. Experimental results on large public datasets demonstrate the effectiveness of our method. The code is open sourced on https://github.com/HuYongting/WGLIN.

Context-Aware Vision Language Foundation Models for Ocular Disease Screening in Retinal Images

Foundation models are large-scale versatile systems trained on vast quantities of diverse data to learn generalizable representations. Their adaptability with minimal fine-tuning makes them particularly promising for medical imaging, where data variability and domain shifts are major challenges. Currently, two types of foundation models dominate the literature: self-supervised models and more recent vision-language models. In this study, we advance the application of vision-language foundation (VLF) models for ocular disease screening using the OPHDIAT dataset, which includes nearly 700,000 fundus photographs from a French diabetic retinopathy (DR) screening network. This dataset provides extensive clinical data (patient-specific information such as diabetic health conditions, and treatments), labeled diagnostics, ophthalmologists text-based findings, and multiple retinal images for each examination. Building on the FLAIR model $\unicode{x2013}$ a VLF model for retinal pathology classification $\unicode{x2013}$ we propose novel context-aware VLF models (e.g jointly analyzing multiple images from the same visit or taking advantage of past diagnoses and contextual data) to fully leverage the richness of the OPHDIAT dataset and enhance robustness to domain shifts. Our approaches were evaluated on both in-domain (a testing subset of OPHDIAT) and out-of-domain data (public datasets) to assess their generalization performance. Our model demonstrated improved in-domain performance for DR grading, achieving an area under the curve (AUC) ranging from 0.851 to 0.9999, and generalized well to ocular disease detection on out-of-domain data (AUC: 0.631-0.913).

AI-Driven Diabetic Retinopathy Diagnosis Enhancement through Image Processing and Salp Swarm Algorithm-Optimized Ensemble Network

Diabetic retinopathy is a leading cause of blindness in diabetic patients and early detection plays a crucial role in preventing vision loss. Traditional diagnostic methods are often time-consuming and prone to errors. The emergence of deep learning techniques has provided innovative solutions to improve diagnostic efficiency. However, single deep learning models frequently face issues related to extracting key features from complex retinal images. To handle this problem, we present an effective ensemble method for DR diagnosis comprising four main phases: image pre-processing, selection of backbone pre-trained models, feature enhancement, and optimization. Our methodology initiates with the pre-processing phase, where we apply CLAHE to enhance image contrast and Gamma correction is then used to adjust the brightness for better feature recognition. We then apply Discrete Wavelet Transform (DWT) for image fusion by combining multi-resolution details to create a richer dataset. Then, we selected three pre-trained models with the best performance named DenseNet169, MobileNetV1, and Xception for diverse feature extraction. To further improve feature extraction, an improved residual block is integrated into each model. Finally, the predictions from these base models are then aggregated using weighted ensemble approach, with the weights optimized by using Salp Swarm Algorithm (SSA).SSA intelligently explores the weight space and finds the optimal configuration of base architectures to maximize the performance of the ensemble model. The proposed model is evaluated on the multiclass Kaggle APTOS 2019 dataset and obtained 88.52% accuracy.

Is an Ultra Large Natural Image-Based Foundation Model Superior to a Retina-Specific Model for Detecting Ocular and Systemic Diseases?

The advent of foundation models (FMs) is transforming medical domain. In ophthalmology, RETFound, a retina-specific FM pre-trained sequentially on 1.4 million natural images and 1.6 million retinal images, has demonstrated high adaptability across clinical applications. Conversely, DINOv2, a general-purpose vision FM pre-trained on 142 million natural images, has shown promise in non-medical domains. However, its applicability to clinical tasks remains underexplored. To address this, we conducted head-to-head evaluations by fine-tuning RETFound and three DINOv2 models (large, base, small) for ocular disease detection and systemic disease prediction tasks, across eight standardized open-source ocular datasets, as well as the Moorfields AlzEye and the UK Biobank datasets. DINOv2-large model outperformed RETFound in detecting diabetic retinopathy (AUROC=0.850-0.952 vs 0.823-0.944, across three datasets, all P<=0.007) and multi-class eye diseases (AUROC=0.892 vs. 0.846, P<0.001). In glaucoma, DINOv2-base model outperformed RETFound (AUROC=0.958 vs 0.940, P<0.001). Conversely, RETFound achieved superior performance over all DINOv2 models in predicting heart failure, myocardial infarction, and ischaemic stroke (AUROC=0.732-0.796 vs 0.663-0.771, all P<0.001). These trends persisted even with 10% of the fine-tuning data. These findings showcase the distinct scenarios where general-purpose and domain-specific FMs excel, highlighting the importance of aligning FM selection with task-specific requirements to optimise clinical performance.